Injury Severity and Psychological Distress Sustained in the Aftermath of the Attacks of 11 September 2001 Predict Somatic Symptoms in World Trade Center Health Registry Enrollees Sixteen Years Later

Somatic and Posttraumatic Stress Symptoms in Children and Adolescents in France

Importance

Somatic symptoms are a major concern among the pediatric population because of frequency and burden. The association between adverse childhood experiences and somatic symptoms in adults is well established but less is known concerning somatic symptoms in young people.

Objective

To explore the frequency and intensity of somatic symptoms in children and adolescents exposed to traumatic events.

Design, Setting, and Participants

This cross-sectional study was conducted from January 1 to December 31, 2021, at the Nice Pediatric Psychotrauma Referral Center in Nice, France. Participants included pediatric outpatients, aged 7 to 17 years, who were referred to the center. Statistical analysis was performed in January 2022.

Exposure

All participants experienced at least 1 traumatic event during life.

Main Outcome and Measure

Somatic and posttraumatic stress symptoms were assessed using the Patient Health Questionnaire-13 (PHQ-13) and Child PTSD Checklist (CPC). Posttraumatic stress disorder (PTSD) and non-PTSD groups were defined based on CPC symptoms severity score. In the hypothesized association between somatic symptoms and posttraumatic stress symptoms (PTSS), PTSD and non-PTSD groups were compared, correlations between PTSS and severity of CPC were analyzed, and a regression model was performed.

Results

There were 363 participants included (mean [SD] age, 13.58 [0.25] years; 174 [47.9%] female, 189 [52.1%] male). Compared with the non-PTSD group, the PTSD group presented with a higher mean (SD) number of somatic symptoms (7.0 [2.5] vs 4.0 [2.5] symptoms; t360 = 11.7; P < .001), and higher mean (SD) intensity (10.4 [4.6] vs 4.8 [3.7] points; t360 = 12.6; P < .001). Most of the explored somatic symptoms positively correlated with the intensity of PTSS and their functional alterations (eg, PTSS intensity correlated with stomach pain symptoms [r = .30; P < .001]; and with headaches symptoms [r = .44; P < .001]). In the regression model, the combination of migraines, palpitation, nausea, tiredness, and sleep disorders explained 6.5% of the variance in the PTSD group. (F1,341 = 22.651; P < .001).

Conclusions and Relevance

In this cross-sectional study, somatic symptoms were positively correlated with PTSS both in frequency and intensity among youths. These results suggest that the systematic screening for somatic symptoms in youths with traumatic exposure should be a routine evaluation procedure.

'The apocalypse': A qualitative pilot study of the psychological aftermath of the 2020 Beirut blast

BACKGROUND

There has been very limited data describing the psychological aftermath of the Beirut blast.

AIMS

This qualitative pilot study aimed to explore the psychological and physical reactions to the trauma experienced by Beirut blast survivors, as well as their coping strategies.

METHODS

From November 2020 to February 2021, in-depth, semi-structured interviews were conducted with eight Lebanese citizens who were within a 4 km radius of the Beirut port at the time of the explosion. A thematic analysis was adopted.

RESULTS

Three themes were identified: (1) the blast; (2) life after the blast: extended trauma; (3) coping strategies. First, almost all participants vividly remembered the moment of the blast and referred to it as a turning point in their lives. They also remembered being on an emotional rollercoaster, feeling physically numb, worried about another explosion and finding God in the midst of tragedy. Second, all participants reported several negative experiences in their post-blast life, which may have enhanced/prolonged their trauma, including losses of different kinds (of a country, home, loved ones, hope, safety/security, culture and heritage), the cumulative impact of the blast, the impossibility to ever return to 'normality', persistent survival guilt and somatisation. Lastly, different coping strategies were adopted to deal with trauma, such as talking it out, establishing a consistent daily routine, helping the community, overworking and detachment.

CONCLUSIONS

This study highlights the many layers of psychological suffering of Beirut blast survivors in the current context of collective distress dominating Lebanon.

Post-Traumatic Growth and Quality of Life among World Trade Center Health Registry Enrollees 16 Years after 9/11

A recent study of World Trade Center Health Registry enrollees found that about one-third experienced post-traumatic growth (PTG) in the wake of the 9/11 attacks and that PTG was associated with social support and social integration. However, the implications of PTG for the enrollees' overall quality of life are unknown. The present study investigated the prevalence of PTG and its association with the SF-12 physical and mental functioning quality of life scales in a sample of 4760 enrollees from the Registry's Health and Quality of Life Study (HQoL) who completed the first four surveys, were older than 18 on 9/11, reported English as their primary spoken language, and provided consistent self-report of 9/11 physical injury at the Registry's baseline and HQoL surveys. We employed multivariable linear regression to evaluate the association between PTG and the SF-12 physical and mental scales, controlling for sociodemographic and other variables. We found that 31% of the sample enrollees experienced PTG and that PTG exhibited a clinically and statistically significant association with the SF-12 mental scale but not the physical scale (physical: b = 0.15 (-0.45, 0.75), mental: b = 3.61 (2.85, 4.37)). Those who were physically injured during 9/11 showed larger improvements in mental functioning than those who were not. PTG has implications for the overall mental quality of life that should be further investigated.

Cortical complexity in world trade center responders with chronic posttraumatic stress disorder

Approximately 23% of World Trade Center (WTC) responders are experiencing chronic posttraumatic stress disorder (PTSD) associated with their exposures at the WTC following the terrorist attacks of 9/11/2001, which has been demonstrated to be a risk factor for cognitive impairment raising concerns regarding their brain health. Cortical complexity, as measured by analyzing Fractal Dimension (FD) from T1 MRI brain images, has been reported to be reduced in a variety of psychiatric and neurological conditions. In this report, we hypothesized that FD would be also reduced in a case-control sample of 99 WTC responders as a result of WTC-related PTSD. The results of our surface-based morphometry cluster analysis found alterations in vertex clusters of complexity in WTC responders with PTSD, with marked reductions in regions within the frontal, parietal, and temporal cortices, in addition to whole-brain absolute bilateral and unilateral complexity. Furthermore, region of interest analysis identified that the magnitude of changes in regional FD severity was associated with increased PTSD symptoms (reexperiencing, avoidance, hyperarousal, negative affect) severity. This study confirms prior findings on FD and psychiatric disorders and extends our understanding of FD associations with posttraumatic symptom severity. The complex and traumatic experiences that led to WTC-related PTSD were associated with reductions in cortical complexity. Future work is needed to determine whether reduced cortical complexity arose prior to, or concurrently with, onset of PTSD.